Solitude and cortisol: Associations with state and trait affect in daily life

The experience of stuttering in everyday life among adults who stutter: The impact of trait social anxiety and the social situations

PURPOSE

The purpose of this study was to investigate the emotional and stuttering experience of adults who stutter (AWS) in everyday life, and how that experience may be shaped by personal (i.e., trait social anxiety) and situational factors (i.e., social partner reaction, communication channel type, social closeness, stuttering knowledge).

METHOD

AWS completed ecological momentary assessments on their smartphones multiple times a day for up to three weeks. Data (n = 62) were analyzed with multilevel models to determine how situational factors and trait social anxiety influence the Negative Affect (NA), Positive Affect (PA), and self-reported stuttering severity of AWS.

RESULTS

Results indicated that having high (vs. low) trait social anxiety was associated with a tendency to experience high NA, low PA, and high self-reported stuttering severity among AWS. A range of situational factors significantly influenced the within-person variation of NA, PA, and self-reported stuttering severity in everyday life. In addition, interacting with distant social partners relative to being alone heightened NA, and the effect was more prominent among AWS with high (vs. low) trait social anxiety.

CONCLUSIONS

Overall, the findings suggest that the variation of affects and stuttering severity among AWS can be partly accounted for by factors from both the situational and personal levels. Clinicians should be aware of the low PA experienced by AWS who have high (vs low) trait social anxiety in everyday life.

Need satisfaction in daily well-being: Both social and solitude contexts contribute to well-being

Daily need satisfaction for relatedness (social connection), autonomy (volitional self-congruent action), and competence (self-efficacy) fosters well-being, but those findings primarily reflect experiences during social interactions. A three-week daily diary study (N = 178) explored psychological need satisfaction in two key everyday contexts: solitude and social. Holding constant the benefits of need-satisfying social contexts, autonomy satisfaction during solitude was key to peaceful affect, whereas competence satisfaction during solitude contributed to lower loneliness; both psychological needs in solitude contributed to evaluating the day as more satisfying. Relatedness-deficiency in solitude did not contribute to loneliness; instead, those who were relatedness-deficient in social interactions felt lonely. Further, need satisfaction in solitude compensated for deficient needs in social contexts, reducing loneliness (autonomy and relatedness) and increasing day satisfaction (all needs) when social contexts failed to satisfy needs. Findings suggest daily solitude can shape daily well-being and further attention is needed to understand and ultimately improve everyday solitude.

Balance between solitude and socializing: everyday solitude time both benefits and harms well-being

Two literatures argue that time alone is harmful (i.e., isolation) and valuable (i.e., positive solitude). We explored whether people benefit from a balance between their daily solitude and social time, such that having 'right' quantities of both maximizes well-being. Participants (n = 178) completed a 21-day diary study, which quantified solitude time in hours through reconstructing daily events. This procedure minimized retrospective bias and tested natural variations across time. There was no evidence for a one-size-fits-all 'optimal balance' between solitude and social time. Linear effects suggested that people were lonelier and less satisfied on days in which they spent more hours in solitude. These detrimental relations were nullified or reduced when daily solitude was autonomous (choiceful) and did not accumulate across days; those who were generally alone more were not, on the whole, lonelier. On days in which people spent more time alone they felt less stress and greater autonomy satisfaction (volitional, authentic, and free from pressure). These benefits were cumulative; those who spent more time alone across the span of the study were less stressed and more autonomy satisfied overall. Solitude time risks lowering well-being on some metrics but may hold key advantages to other aspects of well-being. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on June 1, 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/5KXQ3 .

There is a party in my head and no one is invited: Resting-state electrocortical activity and solitude

OBJECTIVE

What are the motivational underpinnings of solitude? We know from self-report studies that increases in solitude are associated with drops in approach motivation and rises in avoidance motivation, but only when solitude is experienced as non-self-determined (i.e., non-autonomous). However, the extent to which individual differences in solitude relate to neurophysiological markers of approach-avoidance motivation derived from resting-state electroencephalogram (EEG) is unknown. These markers are Frontal Alpha Asymmetry, beta suppression, and midline Posterior versus Frontal EEG Theta Activity.

METHOD

We assessed the relation among individual differences in the reasons for solitude (i.e., preference for solitude, motivation for solitude), approach-avoidance motivation, and resting-state EEG markers of approach-avoidance motivation (N = 115).

RESULTS

General preference for solitude was negatively related to approach motivation, observed in both self-reported measures and EEG markers of approach motivation. Self-determined solitude was positively related to both self-reported approach motivation and avoidance motivation in the social domain (i.e., friendship). Non-self-determined solitude was negatively associated with self-reported avoidance motivation.

CONCLUSION

This research was a preliminary attempt to address the neurophysiological underpinnings of solitude in the context of motivation.

Are you alone? Measuring solitude in childhood, adolescence, and emerging adulthood

The goal of this review was to provide an overview of how solitude has been operationally defined and measured since the year 2000 in psychological studies of children, adolescents, and emerging adults. After applying exclusionary criteria, our review of the extant literature identified n = 19 empirical studies, which we grouped into three broad methodological categories: (1) experiments/manipulations (n = 5); (2) retrospective reports (n = 7); and (3) experience sampling measures (experience sampling methodology; n = 7). A review of these studies indicated considerable variation in how solitude is operationalized and measured. There is also a notable lack of studies measuring solitude in childhood. Implications for 'what matters' when assessing solitude are discussed, and we provide a series of suggestions for helping this research area move forward.

Perceived Support Protects Against Negative Affective Experiences of Momentary Solitude: An Ecological Momentary Assessment Study

OBJECTIVES

Momentary solitude (the objective state of being alone) has a strong association with negative affective experiences in older people, but little is known about how the role of social relationship characteristics on relationship between momentary solitude and affect. We examined the momentary association between momentary solitude and negative affect (NA), and whether such association was moderated by the structural and functional aspects of social relationships.

METHODS

A sample of 153 late-middle-aged and older adults were recruited and provided a total of 6,742 ecological momentary assessment surveys, of which momentary solitudes were reported for 1,885 (28%) surveys. Hierarchical linear model was used to examine how social networks and social support moderated the association of momentary solitude with NA experiences.

RESULTS

The association of momentary solitude with NA experiences was significant among middle-aged and older adults (b = 0.025, SE = 0.008, p < .01). Family networks had the main effect on NA. Perceived social support buffered against increased NA in momentary solitude: Individuals with a higher level of perceived support reported fewer increases in NA during momentary solitude than those perceiving a lower level of support.

DISCUSSION

Momentary solitude was experienced less negatively for middle-aged and older persons embedded in a context of higher levels of perceived social support. Practitioners need to pay more attention to the promotion of social resources when delivering programs to improve the subjective well-being of late-middle-aged and older adults.

Alone with my phone? Examining beliefs about solitude and technology use in adolescence

In this study, we examined how technology impacts adolescents' perceptions of, and affective responses to solitude, as well as how adolescents' own motivations for solitude (shyness, affinity for aloneness) were related to these reactions. Participants were N = 437 adolescents (297 girls; M age = 16.15 years, standard deviation (SD) = .50) who were presented with a series of hypothetical vignettes asking them to imagine themselves in the context of pure solitude (alone in their room with the door closed), as well as being physically alone but engaged in increasing levels of virtual social engagement, including passive (e.g., watching videos, scrolling, but no direct social engagement), active (e.g., texting), and audio-visual (e.g., Facetime) technology use. Following each vignette, participants reported their perceptions of being alone and positive/negative affective responses. We also measured general motivations for solitude (shyness, affinity for aloneness). Among the results, adolescents perceived themselves as less alone in vignettes depicting increasing virtual social engagement. Affective benefits of increased virtual engagement were also found (e.g., less loneliness/boredom/sadness, greater social connection/contentment). However, these effects were moderated by solitude motivations, with different patterns evident as a function of participant shyness and affinity for aloneness. Findings highlight the importance of considering the nature of adolescents' technology use when alone, as well as motivations for solitude, when considering links between solitude and well-being.

The mediating role of loneliness on relations between face-to-face and virtual interactions and psychological well-being across age: A 21-day diary study

Lack of social interaction is associated with a heightened sense of loneliness and, in turn, poorer psychological well-being. Despite the prevalence of communicating with others virtually even when physically alone, whether the social interaction–loneliness–well-being relationship is different between face-to-face and virtual interactions and between younger and older adults is relatively understudied. This 21-day diary study examined this question among younger ( n = 91; Mage = 22.87) and older ( n = 107; Mage = 64.53) Hong Kong participants during the early stage of the COVID-19 pandemic (March–May 2020). We found significant indirect effects of shorter face-to-face interaction time on poorer psychological well-being via a heightened sense of loneliness at the within-person level only among younger adults and at the between-person level only among older adults. Independent of loneliness, spending more time with others on virtual interactions was associated with better psychological well-being only among older adults. Taken together, while the mechanisms may be different across age groups, face-to-face interaction remains an effective way to reduce loneliness and enhance psychological well-being even at times when it is discouraged (e.g., pandemic). Although virtual interaction does not reduce loneliness, its positive impact on older adults’ well-being sheds light on the utility of promoting technological acceptance in late adulthood.

Solitude and affect during emerging adulthood: When, and for whom, spending time alone is related to positive and negative affect during social interactions

The present study examines within- and between-person associations between emerging adults’ daily time spent alone and their positive/negative affect during social interactions. We also consider whether motivations for seeking solitude (shyness, unsociability, avoidance) moderate these associations. Participants were 411 emerging adults (ages 18–26 years; 51% female; 52% ethnic minority) who reported on their motivations for solitude and completed daily reports of their time spent alone and positive/negative affect experienced during social interactions for 7 consecutive days. Among the results, multi-level modeling indicated that on days when emerging adults spent more time alone than usual, they experienced increased levels of high and low arousal positive affect when they interacted with others. Interactions between shy and avoidant motivations and change in time spent alone also emerged, with follow-up analyses indicating that for highly and moderately shy and avoidant emerging adults, days with more time spent alone than usual were associated with greater reports of anxious affect during social interactions. Findings suggest that although many emerging adults may find social interactions more enjoyable on days with increased time alone, those who actively seek solitude as an escape from perceived stressful or unpleasant social circumstances may not.

A dual-system, machine-learning approach reveals how daily pubertal hormones relate to psychological well-being in everyday life

The two studies presented in this paper seek to resolve mixed findings in research linking activity of pubertal hormones to daily adolescent outcomes. In study 1 we used a series of Confirmatory Factor Analyses to compare the fit of one and two-factor models of seven steroid hormones (n = 994 participants, 8084 samples) of the HPA and HPG axes, using data from a field study (https://www.icpsr.umich.edu/web/ICPSR/studies/38180) collected over ten consecutive weekdays in a representative sample of teens starting high school. In study 2, we fit a Bayesian model to our large dataset to explore how hormone activity was related to outcomes that have been demonstrated to be linked to mental health and wellbeing (self-reports of daily affect and stress coping). Results reveal, first that a two-factor solution of adolescent hormones showed good fit to our data, and second, that HPG activity, rather than the more often examined HPA activity, was associated with improved daily affect ratios and stress coping. These findings suggest that field research, when it is combined with powerful statistical techniques, may help to improve our understanding of the relationship between adolescent hormones and daily measures of well-being.

The human physiology of well-being: A systematic review on the association between neurotransmitters, hormones, inflammatory markers, the microbiome and well-being

To understand the pathways through which well-being contributes to health, we performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines on the association between well-being and physiological markers in four categories, neurotransmitters, hormones, inflammatory markers, and microbiome. We identified 91 studies. Neurotransmitter studies (k_{number of studies}=9) reported only a possible positive association between serotonin and well-being. For the hormone studies (k = 48), a lower momentary cortisol level was related to higher well-being (meta-analytic r = -0.06), and a steeper diurnal slope of cortisol levels. Inflammatory marker studies (k = 36) reported negative or non-significant relations with well-being, with meta-analytic estimates of respectively r = -0.07 and r = -0.05 for C-reactive protein and interleukin-6. Microbiome studies (k = 4) reported inconsistent associations between different bacteria abundance and well-being. The results indicate possible but small roles of serotonin, cortisol, and inflammatory markers in explaining differences in well-being. The inconsistent and limited results for other markers and microbiome require further research. Future directions for a complete picture of the physiological factors underlying well-being are proposed.

Lifestyle factors and psychological well-being: 10-year follow-up study in Lithuanian urban population

Background

Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population.

Methods

In the baseline survey (2006 to 2008), 7115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis.

Results

After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p < 0.05) compared to less frequent consumption of such food groups. Dose-response relationship between increasing number of healthy lifestyle factors and higher PWB was determined both in men and women.

Conclusions

Lifestyle factors such as never smoking and former smoking, high social activity, and more frequent fresh vegetable and fruit consumption increased the odds of higher PWB over 10 years of follow-up in men and women groups. The increase of the protective health behaviour score was directly associated with the odds of higher PWB.

Solitary Prosociality in Later Life: An Experience Sampling Study

Loneliness is a risk factor for older adults, one exacerbated by the COVID-19 pandemic. Although time spent alone is associated with both loneliness and greater well-being, the experience of solitude may depend on the type of activity pursued. We examined formal prosocial activity as one facilitator of positive solitary experiences. Older adults (N = 165, M_age = 71.13, SD = 5.70) highly committed to prosocial-program work (e.g., tutoring) filled out surveys at six random times every day for a week. Using multilevel modeling, we investigated whether participating in prosocial-program activity alone was associated with greater well-being compared to other solitary activity. While prosocial-program activity did not buffer against negative affect in solitude, it promoted positive affect and relatedness when alone. To the extent that prosocial-program work can facilitate positive solitary experiences by enhancing feelings of connection, it may protect against threats to well-being posed by loneliness in later life.

Choice Matters More with Others: Choosing to be with Other People is More Consequential to Well-Being than Choosing to be Alone

Stable social relationships are conducive to well-being. However, similar effects are not reported consistently for daily social interactions in affecting episodic (experiential) subjective well-being (ESWB). The present investigation suggests that the choice of being in a social context plays an important moderating role, such that social interactions increase ESWB only if taken place by one's choice. Moreover, it is argued that choice matters more in a social context than in an alone context because experiences with others are amplified. These ideas were tested and supported in two studies: An experiment that manipulated social context and choice status, and a 10-day experience-sampling study, which explored these variables in real-life settings. Results showed that being with others by one's choice had the strongest positive association with ESWB, sense of meaning, and control, whereas being with others not by one's choice-the strongest negative association with ESWB. Effects of being alone on ESWB also varied by choice status, but to a lesser extent. The findings offer theoretical and practical insights into the effects of the social environment on well-being.

What Time Alone Offers: Narratives of Solitude From Adolescence to Older Adulthood

Solitude – the state of being alone and not physically with another – can be rewarding. The present research explored the potential benefits of solitude from a pragmatist approach: a ground-up, top-down perspective that is receptive to new knowledge but informed by theory. Participant recruitment was stratified by age and gender, and the sample involved 2,035 individuals including adolescents (13–16 years), adults (35–55 years), or older adults (65+ years). Data were analyzed with a mixed-methods approach. Coded themes from brief narratives about solitude were extracted, and their frequencies (i.e., their salience to participants) were compared across the lifespan. Themes were then correlated with two indicators of well-being in solitude: self-determined motivation for solitude and peaceful mood. Several prominent themes emerged when talking about time spent in solitude. With the exception of feeling competent in solitude, which was described frequently but consistently unrelated to self-reported well-being regardless of age, benefits of solitude tended to shift over the lifespan. Some qualities, such as a sense of autonomy (self-connection and reliance; absence of pressure), were salient and consequential for everyone, but increasingly so from adolescence to older adulthood. Older adults also reported feeling most peaceful in solitude and described their social connection and alienation less frequently, suggesting they see solitude and social time as more distinct states. Findings are discussed in light of existing work on solitude across the lifespan, and theoretical frameworks that spoke well to the data (e.g., self-determination theory).

Positive and negative affect are associated with salivary cortisol in the everyday life of older adults: A quantitative synthesis of four aging studies

Research on time-fluctuating links between positive affect and cortisol is inconsistent and mostly based on young to middle-aged samples. The current project investigated how moment-to-moment changes in positive and negative affect are associated with moment-to-moment changes in cortisol levels in older adults' daily lives and whether those associations are moderated by differences in health status (as indicated by the number of comorbidities). Affect and cortisol data collected in four separately conducted momentary assessment studies with parallel protocols were pooled to obtain a sample of N=476 individuals aged 56-88 years (M_age=71.9, SD=6.6; 52% female). Participants provided affect reports and collected salivary cortisol 5-7 times a day for a 7-day period and reported the presence of 13 different health conditions. Data were analyzed using multilevel models, with time since waking, daily behaviors associated with cortisol secretion, age, and sex controlled. Feeling more positive affect than usual was associated with lower momentary cortisol. In contrast, feeling more negative affect than usual was associated with higher momentary cortisol. Associations of momentary positive and negative affect with cortisol were weaker among participants in worse as compared to those in better health. Trait positive affectivity was associated with more curvature of waking cortisol profiles and trait negative affectivity was associated with smaller cortisol awakening responses. Findings suggest that HPA axis responses fluctuate with everyday changes in positive and negative affect in older adults, and that higher HPA reactivity may indicate preserved health in this age group.

Intra-individual Associations of Perceived Stress, Affective Valence, and Affective Arousal with Momentary Cortisol in a Sample of Working Adults

BACKGROUND

Research pairing ecological momentary assessment (EMA) methodology and ambulatory cortisol during daily life is still rare, as is careful testing of the within-person associations between stress, affect, and cortisol. Using a circumplex approach, we considered both valence and arousal components of affect.

PURPOSE

To examine the within-person covariation of momentary cortisol with momentary perceived stress, affective valence, and affective arousal in everyday life.

METHODS

115 working adults (Mage = 41.2; 76% women; 76% white) completed six EMA surveys per day over 3 days. Each assessment included reports of perceived stress and affect (used to construct indicators of affective valence and arousal), followed by a saliva sample (from which cortisol was assessed). Multi-level models were used to examine the momentary associations between perceived stress, affective valence, affective arousal, and cortisol.

RESULTS

Moments characterized by higher perceived stress were associated with higher cortisol (p = .036). Affective valence covaried with cortisol (p = .003) such that more positive valence was associated with lower cortisol and more negative valence with higher cortisol. Momentary affective arousal was not related to cortisol (p = .131). When all predictors were tested in the same model, only valence remained a significant predictor of cortisol (p = .047).

CONCLUSION

Momentary perceived stress and affective valence, but not affective arousal, were associated with naturalistic cortisol. Cortisol was more robustly associated with affective valence than perceived stress or affective arousal. These findings extend our understanding of how moments of stress and particular characteristics of affective states (i.e., valence but not arousal) may "get under the skin" in daily life.

Exploring the autism spectrum: Moderating effects of neuroticism on stress reactivity and on the association between social context and negative affect

Neuroticism is associated with increased stress reactivity. In autism spectrum disorders (ASD), emotional stress reactivity is increased and there is some evidence for an increased negative affect (NA) when with less familiar people. The aim of this study was to compare adults with ASD and controls on levels of neuroticism and on interactions between neuroticism and appraised stress or social context in models of NA. This is a cross-sectional observational study comprising a group of 50 adults with ASD and 51 controls. Experience sampling method (ESM) reports were collected for 10 days to measure daily life stress, mood, and social context. Multilevel regression analyses revealed significantly higher neuroticism levels in ASD than in controls. Adults with ASD who scored high on neuroticism showed a significantly stronger association between activity/social stress and NA (i.e., higher stress reactivity) than those with low scores. Furthermore, the association between neuroticism and NA was stronger when adults with ASD were with less familiar people compared with being alone or with familiar people. No consistent corresponding significant interactions were found in the control group. In conclusion, in ASD, neuroticism moderates the association between appraised stress and NA as well as the association between social context and NA.

Arts engagement trends in the United Kingdom and their mental and social wellbeing implications: HEartS Survey

Evidence on the role of the arts in promoting health and wellbeing has grown over the last two decades. In the United Kingdom, studies using secondary data sources have documented temporal variations in levels of arts engagement in the population, its determinants and its mental wellbeing implications. However, arts engagement is often characterized by prioritizing "high-brow" art forms. In this article, we introduce the HEartS Survey, a tool that aims to increase the balance between inclusivity and brevity of existing arts engagement measures and to focus specifically on the connection between arts engagement and social wellbeing. We explore trends in participatory and receptive engagement with literary, visual, performing, crafts and decorative arts among 5,338 adults in the UK in 2018-2019 using summative engagement scores and cluster analysis. Regression models, adjusted for demographic, socioeconomic, health, and social covariates, examine correlations between arts engagement and psychological and social wellbeing measures. Over 97% of respondents reported engagement in one or more arts activities at least once during 2018-2019, with reading and listening to music being the most popular activities. Arts engagement grouped into three distinct clusters: 19.8% constituted "low engagers" whose main source of engagement was occasional reading; 44.4% constituted "receptive consumers" who read and listened to music frequently and engaged with popular receptive arts activities such as cinema, live music, theater, exhibitions, and museums; and 35.8% constituted "omnivores" who frequently engaged in almost all arts activities. In agreement with existing studies, more arts engagement was associated with higher levels of wellbeing, social connectedness, and lower odds of intense social loneliness. In contrast, we found a positive association between more arts engagement, depression, and intense emotional loneliness for the most highly engaged omnivores. We conclude that arts engagement in the population forms specific profiles with distinct characteristics and consider implications for mental and social wellbeing.

Momentary emotions and salivary cortisol: A systematic review and meta-analysis of ecological momentary assessment studies

An integrated view of the stress response requires consideration of both the emotional and hormonal sequelae of stress, which are regulated by the hypothalamic-pituitary-adrenal (HPA) axis. Understanding the extent of the association between emotions and cortisol at the momentary level can shed light on the biopsychological pathways linking stress to health. Research in this area has adopted heterogeneous approaches and produced mixed findings; thus, it is critical to conduct a systematic review and meta-analysis. Systematic searches in major databases identified 22 studies (negative emotions [k = 19; 38,418 momentary observations]; positive emotions [k = 15; 31,721 momentary observations]). Meta-analysis found a significant positive association between momentary negative emotions and cortisol (r = .06, p < .001) and a significant negative association between momentary positive emotions and cortisol (r = -.05, p = .003). No methodological differences moderated these associations. Our findings suggest that emotional states correlate with cortisol levels at the momentary level. We discuss the health implications of our findings and provide recommendations for advancing this area of research.

The Language of Being Alone and Being With Others

Abstract. This article explores people’s perception of their experience while being alone or being with others. To that aim, data from nine studies (total N = 1,717) were meta-analyzed. In each study, participants performed a sentence-completion task referring to their experience alone/“with others”. The responses were analyzed using a text analysis software. Results showed that in a “with others” (vs. alone) mindset, people are more focused on the present, and less focused on the past or the future. When “with others,” more anxiety but less sadness is expressed. Social motives – affiliation and power – are more pronounced in the “with others” mindset, whereas leisure activities are salient in the alone mindset. Conclusions are derived regarding the nature of the experience in these basic conditions.

Long-Term Impact of Social Isolation and Molecular Underpinnings

Prolonged periods of social isolation can have detrimental effects on the physiology and behavior of exposed individuals in humans and animal models. This involves complex molecular mechanisms across tissues in the body which remain partly identified. This review discusses the biology of social isolation and describes the acute and lasting effects of prolonged periods of social isolation with a focus on the molecular events leading to behavioral alterations. We highlight the role of epigenetic mechanisms and non-coding RNA in the control of gene expression as a response to social isolation, and the consequences for behavior. Considering the use of strict quarantine during epidemics, like currently with COVID-19, we provide a cautionary tale on the indiscriminate implementation of such form of social isolation and its potential damaging and lasting effects in mental health.

Latino adolescents' cultural values associated with diurnal cortisol activity

Hypothalamic-pituitary-adrenal (HPA) axis activity has been identified as a mechanism through which daily life stress contributes to health problems and racial/ethnic health disparities. Stress-related changes in neuroendocrine function are evident as early as adolescence, but the ways in which promotive cultural factors may also contribute to variation in diurnal HPA activity have received little empirical attention. Grounded in cultural models of resilience, dual dimensions of Latino adolescents' cultural values (ethnic heritage and U.S. mainstream) were examined as promotive and protective factors in relation to their diurnal salivary cortisol patterns using ecological momentary assessment (N = 209; M_age = 18.10; 64.4% female). Participants provided 5 daily saliva samples for 3 days while completing corresponding electronic diary reports and using time-sensitive compliance devices (track caps, actigraphs). Results from 3-level growth curve models indicated that higher U.S. mainstream cultural values (e.g., self-reliance, competition, material success) were associated with higher average waking cortisol levels and a more rapid rate of diurnal cortisol decline (i.e., "steeper" slope). Regarding situational deviations from the diurnal rhythm (within-person differences), cortisol levels were higher in relation to diary-reported ongoing stress (vs. completed). Accounting for these situational differences in stress timing, a cross-level interaction (i.e., between-person difference in within-person process) indicated that higher perceived stress than usual was associated with lower cortisol levels for adolescents with stronger alignment to Latino ethnic heritage values (e.g., familism, respect, religiosity), compared to relatively higher cortisol levels for those with less alignment to these values. Results were consistent adjusting for participants' sex, immigrant generation, parents' education level, depressive symptoms, medication use, sleep duration, and other self-reported health behaviors. These findings join the growing science of cultural neurobiology by demonstrating the promotive and potentially regulating influence of cultural values in the daily HPA functioning of Latino adolescents.

Everyday solitude, affective experiences, and well-being in old age: the role of culture versus immigration

Objectives: Being alone is often equated with loneliness. Yet, recent findings suggest that the objective state of being alone (i.e. solitude) can have both positive and negative connotations. The present research aimed to examine (1) affective experience in daily solitude; and (2) the association between everyday affect in solitude and well-being. We examined the distinct roles of culture and immigration in moderating these associations. Method: Using up to 35 daily life assessments of momentary affect, solitude, and emotional well-being in two samples (Canada and China), the study compared older adults who aged in place (local Caucasians in Vancouver , Canada and local Hong Kong Chinese in Hong Kong, China) and older adults of different cultural heritages who immigrated to Canada (immigrated Caucasians and immigrated East Asians). Results: We found that older adults of East Asian heritage experienced more positive and less negative affect when alone than did Caucasians. Reporting positive affect in solitude was more positively associated with well-being in older adults who had immigrated to Canada as compared to those who had aged in place. Conclusions:These findings speak to the unique effects of culture and immigration on the affective correlates of solitude and their associations with well-being in old age.

Investigating associations between momentary stress and cortisol in daily life: What have we learned so far?

Since cortisol measurement in saliva has been established, it has been used as an indicator of stress-related hypothalamic-pituitary-adrenocortical axis activity. Concurrent development of methodological frameworks such as ambulatory assessment, ecological momentary assessment, and experience sampling have provided opportunities to combine both approaches in daily life research. The current review provides a summary of basic methodological principles and recommendations, as well as abstracts of findings of studies investigating momentary associations between stress and cortisol in daily life with an emphasis on within-subject associations (i.e. average covariance in repeated momentary assessments of stress and cortisol, and individual-specific deviations from the average covariance). Methodological challenges related to stress measurement, sampling principles, and appropriate statistical modeling are discussed, followed by a description of the historical development of studies on within-subject associations between momentary daily life stress and cortisol. The review concludes with a discussion of controversial methodological characteristics of these studies regarding operationalizations of stress, compliance, timing and frequency of stress and cortisol sampling, and reporting of effect sizes. Future research in this area would benefit from automated cortisol assessment, broadening of the scope of stress response measures, use of advanced statistical models that better account for dynamics in the stress process in daily life, and attempts to replicate findings. While previous studies of momentary stress and concurrent cortisol assessments have reliably confirmed some fundamental predictions from stress theory in daily life, future studies should aim at providing progress by testing innovative research questions and utilizing new technological developments.

An examination of the effect of loneliness on the innovative behavior of health science faculty students

BACKGROUND

Contributing to the innovative behavior of individuals in the health management process is a desirable condition for increased health institution performance. The relationship between the sense of loneliness and individual innovation behaviors has not been studied and relevant literature is extremely limited. The purpose of this research was to examine the effect of an individual's sense of loneliness on their innovative behavior.

METHODS

The research was performed between January and October 2018. The effects of loneliness feelings on the individual innovative behaviors of 451 health science faculty students were measured. The data were collected using the "Individual Information Form," the "individual innovation scale," and the "University of California Los Angeles loneliness scale." The reliability and validity of the scales were tested with Structural Equation Modeling.

RESULTS

It was found that the female participants showed exhibited more innovative behavior than the men. However, there was no significant difference in the loneliness status of participants by gender. A group of 23-year-old individuals showed a significant difference in the risk taking dimension compared to other age groups. First-grade students had more points in the experimental openness and opinion leadership sub-dimension than the other classes. It was observed that the behavior is molded as the education level increases. The regression models showed that loneliness has a negative effect of -0.254 on experiential openness and the leadership of ideas, and has a negative effect of -0.216 on risk taking. There was no effect of the sub-dimensions of loneliness on change resistance. Moreover, on the individualistic behavior of physical loneliness, a -0.267 negative effect was observed. Emotional loneliness has no effect on the sub-dimensions of individual innovation. Finally, the total sense of loneliness was found to have a negative effect on total individual innovation.

CONCLUSIONS

The study results clearly show that physical loneliness has a negative effect on individual innovation. It can be said that individuals living in social environments exhibit more innovative behaviors. However, emotional loneliness has no significant effect on innovative behavior. In this context, designing social spaces in health institutions will stimulate individuals' innovative behaviors.

Interactions of momentary thought content and subjective stress predict cortisol fluctuations in a daily life experience sampling study

Daily life stress is an omnipresent phenomenon in modern society. Research has linked prolonged activation of the hypothalamic-pituitary-adrenal axis to psychiatric and somatic diseases. Everyday stressors substantially contribute to these health risks. Despite the notion that the physiological stress response is highly dependent on concurrent psychological processes, investigations associating diurnal cortisol levels with subjective experience have primarily focused on affective states. The impact of everyday cognitive processes including thought content has been largely neglected. To investigate this link, moment-to-moment associations of psychological experience including subjective stress, thought content and affect, and cortisol levels were assessed throughout the daily routines of 289 healthy adult participants. We found that subjective stress interacted with current thought content and affect in predicting cortisol release: more negative and future-directed thoughts were associated with higher cortisol levels after experiencing subjective stress, suggesting an increase in negative future anticipation. Concurrent cortisol rises might reflect proactive coping to adequately prepare for upcoming demands. In the absence of subjective stress, more past-directed thoughts and negative affect were associated with higher cortisol levels. These findings provide evidence for a fundamental link between thought content and daily cortisol activation, and highlight the significant contribution of thought patterns to physiological stress levels.

Loneliness in older adults is associated with diminished cortisol output

OBJECTIVE

Loneliness in older adults has been associated with increased mortality and health problems. One of the assumed underlying mechanisms is dysregulation of the hypothalamic-pituitary-adrenocortical axis (HPA-axis). The purpose of this study was to investigate whether loneliness in older adults is associated with HPA-axis dysregulation and whether this association differs between depressed and non-depressed persons.

METHODS

Cross-sectional data of 426 lonely and non-lonely older adults in the Netherlands Study of Depression in Older Persons (NESDO) were used. Linear regression analyses and multinominal logistic regression analyses were performed to examine the association between loneliness and morning cortisol, cortisol awakening response, diurnal slope and dexamethasone suppression ratio. In all analyses, confounders were introduced. In order to examine whether the association between loneliness and cortisol measures is different in depressed versus non-depressed persons, an interaction term for loneliness x depression diagnosis was tested.

RESULTS

Cortisol output in the first hour after awakening and dexamethasone suppression ratio was lower in lonely participants. There were no significant interactions between loneliness and depression diagnosis in the association with the cortisol measures.

CONCLUSION

This study is the first to investigate the association between the HPA-axis and loneliness in a large group of older adults aged 60-93years. We found lower cortisol output in the first hour after awakening and lower dexamethasone suppression ratio in lonely older depressed and non-depressed adults. Whether diminished cortisol output is the underlying mechanism that leads to health problems in lonely older adults is an interesting object for further study.

How We Experience Being Alone: Age Differences in Affective and Biological Correlates of Momentary Solitude

Background: Spending time alone constitutes a ubiquitous part of our everyday lives. As we get older, alone time increases. Less is known, however, about age differences in the experience of spending time alone (momentary solitude). Objectives: We examined time-varying associations between momentary solitude, affect quality, and two hypothalamic-pituitary-adrenal axis activity markers [salivary cortisol; dehydroepiandrosterone sulfate (DHEAs)] to better understand the affective and biological correlates of momentary solitude across the adult life span. Method: A total of 185 adults aged 20-81 years (mean age = 49 years, 51% female, 74% Caucasian) completed questionnaires on momentary solitude (alone vs. not alone) and current affect on a handheld device, and provided concurrent saliva samples up to seven times a day for 10 consecutive days. Data were analyzed using multilevel models, controlling for the overall amount of time participants spent alone during the study (overall solitude). Results: Greater overall solitude was associated with decreased average high arousal positive affect and increased average cortisol and DHEAs levels. Momentary solitude was associated with reduced high arousal positive affect, increased low arousal positive affect, and increased low arousal negative affect. Age by momentary solitude interactions indicate that greater age was associated with increased high arousal positive affect and reduced low arousal negative affect during momentary solitude. Furthermore, momentary solitude was associated with increased cortisol and DHEAs. With greater age, the association between momentary solitude and cortisol weakened. Conclusion: Consistent with the negative connotations to loneliness and objective social isolation, greater overall solitude was associated with negative affective and biological correlates. Spending a large overall amount of time alone in old age might thus have negative ramifications for health and well-being. Momentary solitude, in contrast, can be a double-edged sword as evidenced by both positive and negative well-being implications. Importantly, greater age is linked to more favorable affective and biological correlates of momentary solitude. The momentary state of spending time alone is thus an experience that is not necessarily negative and that may improve with aging.

Alone, Unhappy, and Demotivated

This study explored how a mind-set associated with being alone affects self-regulation among individuals varying in neuroticism. Neuroticism is associated with a dualistic approach to the social world—evaluation apprehension alongside need for approval. Consequently, in public contexts, neuroticism leads individuals to experience low pleasantness alongside high motivation. The impact of neuroticism on behavior alone is rarely studied. However, the absence of a social motivator (i.e., potential for approval) should bring neuroticism to be associated with low pleasantness alongside low motivation. Three studies supported these predictions using an alone/public social context mind-set manipulation. Higher neuroticism was associated with lower declared willingness to exert effort (Study 1) and with lower actual effort expenditure (Studies 2a, 2b) in an alone mind-set than in a public mind-set. Additionally, across conditions, neuroticism was associated with low pleasantness. Thus, neuroticism reduces individuals’ willpower in the context of merely thinking about being alone.

Perceived stress, coping, and cortisol reactivity in daily life: A study of adolescents during the first year of college

Adolescents change how they cope with stress across different situations, but also differ from one another in their general capacity to cope. The current study examined whether cortisol reactivity to perceived daily stress varies with both situational (within-person) and individual (between-person) differences in coping. First-year college students (N=63; Mage=18.85) provided 15 stress-coping diaries and 15 corresponding saliva samples across 3 weekdays. Results from hierarchical linear growth models revealed that perceiving greater stress than usual in the last hour was significantly associated with elevations in cortisol (relative to diurnal patterning) only during situations characterized by greater than usual diary-reported engagement coping. Regarding individual differences, perceiving greater stress than usual was significantly associated with elevations in cortisol only for adolescents below average on trait measures of engagement coping or belief in their ability to handle stress. Findings indicate that cortisol reactivity to daily stress varies with both situational variation and individual differences in coping.

Multiple time courses of salivary alpha-amylase and dimensions of affect in adolescence

Previous research has illustrated associations among daily experiences, emotions and stress-responding physiological systems. Recently, investigators have examined salivary alpha-amylase (sAA), a surrogate marker of the autonomic nervous system, and its associations with affect. The current study examined associations among affective valence, arousal and sAA across three different time courses at the momentary, daily and inter-individual level to understand varying influences of adolescents' daily emotional experiences on sAA reactivity and diurnal sAA activity. Adolescents (N=82) provided salivary samples and diary reports of affect and experiences five times a day for three consecutive days. They also completed self-report questionnaires on trait affect. Findings from multilevel growth curves demonstrated that adolescents in our sample displayed typical sAA diurnal rhythms with levels dropping 30 min after waking and then increasing across the day to a peak in the late afternoon. Within person momentary experiences of high arousal positive affect were associated with momentary sAA reactivity. Prior day experiences of high arousal negative affect were associated with a greater amylase awakening response (i.e., greater decrease) and flatter slopes the next day. Trait positive affect was also associated with flatter sAA slopes. Our findings suggest that both affective arousal and valence should be accounted for when examining differences in sAA reactivity and diurnal patterns. Further, our results indicated that emotion-physiology transactions among adolescents occur over varying time scales for salivary alpha-amylase as well as cortisol.

Study protocol: psychological and physiological consequences of exposure to mass media in young women - an experimental cross-sectional and longitudinal study and the role of moderators

BACKGROUND

Repeated exposure to thin beauty ideals is part of the daily routine. Exposure to thin ideals via mass media plays an important role in the development and maintenance of eating disorders (EDs), low self-esteem, depressive or anxious feelings in young females. It is important to elucidate the circumstances under which exposure to thin ideals develops its detrimental impact and to investigate whether these features are more pronounced in EDs than in other mental disorders also related to negative body image.

METHODS/DESIGN

We investigate the following key questions: (1) Does laboratory induced exposure to thin ideals (waiting room design) relate to impairments in terms of body image, affect and eating behavior and biological stress response (salivary alpha-amylase, salivary cortisol, heart rate and heart rate variability) in 18 to 35 year old female suffering from anorexia and bulimia nervosa (AN, BN) compared to female healthy controls and to a sample of females suffering from mixed mental disorders (depression, anxiety and somatic symptom disorder (SSD) disorders)? (2) How do moderators such as cognitive distortions ("Thought-Shape Fusion, TSF"), and correlates of emotion regulation (ER) moderate the influence of the exposure? (3) Are these characteristics amenable to change after treatment? Altogether 250 female participants including patients with AN, BN, depressive, anxiety and SSD disorders, and healthy women will be recruited in Switzerland and Germany.

DISCUSSION

The findings will provide knowledge about the role of moderators influencing the effects of exposure to thin ideals promoted by mass media in eating disorder (ED) patients, patients suffering from mixed mental disorders and healthy controls. Evaluating their differential susceptibility will contribute to a better understanding of the role of negative body image in the maintenance of not only symptoms of ED, but also of depression, anxiety and SSD. Additionally our results will shed light on the stability of effects in healthy controls as well as in the patient groups before and after treatment as usual. Findings foster the development of tailored interventions including a training in specific ER strategies as well as cognitive restructuring of distorted beliefs about the own body when confronted with thin ideals.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00005709. Date of registration: 6(th) of February, 2014.

Contextual moderators of momentary cortisol and negative affect in adolescents' daily lives

PURPOSE

To use an ecological momentary assessment design to examine the links between momentary negative affect and cortisol in a sample of adolescents preparing to transition to college. Guided by a risk and resilience framework, we also explored whether important ecological factors, perceived discrimination and social support, moderated the momentary associations between negative affect and youths' cortisol.

METHODS

Adolescents (N = 77) provided salivary samples and diary reports of affect and experiences five times a day over 3 days. They also completed self-report questionnaires on perceived discrimination and social support from family and friends.

RESULTS

Within-person increases in momentary negative affect were associated with increases in cortisol. Perceived discrimination and social support from friends moderated this association. Adolescents who reported average and high levels of perceived discrimination experienced exaggerated cortisol responses to negative affect, whereas adolescents who reported low levels of perceived discrimination did not experience significant reactivity to negative affect. In contrast, adolescents who reported high levels of social support from friends experienced attenuated cortisol responses to negative affect compared with adolescents who reported average or low levels of social support from friends.

CONCLUSIONS

This study contributes to our understanding of youths' daily socioemotional experiences and physiological reactivity by identifying how perceived discrimination and social support from friends amplified and attenuated, respectively, the effects of negative affect on cortisol reactivity. Examining these processes within adolescents' naturalistic environments advances our understanding of the moderating role of ecological characteristics in adolescents' everyday lives.

Are flatter diurnal cortisol rhythms associated with major depression and anxiety disorders in late adolescence? The role of life stress and daily negative emotion

Alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been associated with major depression disorder (MDD) and some anxiety disorders. Few researchers have tested the possibility that high levels of recent life stress or elevations in negative emotion may partially account for the HPA axis alterations observed in these disorders. In a sample of 300 adolescents from the Youth Emotion Project, we examined associations between MDD and anxiety disorders, dimensional measures of internalizing symptomatology, life stress, mood on the days of cortisol testing, and HPA axis functioning. Adolescents with a past MDD episode and those with a recent MDD episode comorbid with an anxiety disorder had flatter diurnal cortisol slopes than adolescents without a history of internalizing disorders. Higher reports of general distress, a dimension of internalizing symptomatology, were also associated with flatter slopes. Negative emotion, specifically sadness and loneliness, was associated with flatter slopes and partially accounted for the associations between comorbid MDD and anxiety disorders and cortisol. The associations between past MDD and cortisol slopes were not accounted for by negative emotion, dimensional variation in internalizing symptomatology, or levels of life stress, indicating that flatter cortisol slopes may also be a "scar" marker of past experiences of MDD.

How stable are diurnal cortisol activity indices in healthy individuals? Evidence from three multi-wave studies

BACKGROUND

Indices of cortisol activity, including the cortisol awakening response (CAR), diurnal slope, and cortisol output across the day (total daily output), are often studied as mechanistic indicators that could link stress with health. Yet there is a paucity of data speaking to their temporal features, particularly whether they behave in a more state- or trait-like manner across time.

METHODS

To address this issue, data from 3 studies were used to assess CAR, diurnal slope and total daily output stability over different age groups and time spans: 130 healthy children and adolescents collected salivary cortisol samples 5 times/day (1, 4, 9 and 11h after wake) over 2 days at 5 visits spaced 6 months apart (Study 1); 147 adolescent girls collected saliva 6 times/day (wake, 1, 4, 9 and 14 h after wake) for 2 days at 3 visits, each a year apart (Study 2); and 47 healthy, primarily middle age adults collected saliva 6 times/day (wake, 1, 4, 9 and 14 h after wake) for 3 days at 4 visits spaced 2-3 months apart (Study 3). Stability was estimated by multilevel model-derived intraclass correlation coefficients (ICCs).

RESULTS

Across studies, approximately 50% of the variance in cortisol indices was attributable to day-to-day fluctuations, suggesting state-like properties. Of the indices, total daily output emerged as the most stable over time, followed by diurnal slope and CAR, but stability estimates were generally quite modest regardless of index and sample. Over time spans of >1 year, ICCs were ≤ .13.

CONCLUSIONS

Most of the variance in CAR, diurnal slope and total daily output reflects day-to-day fluctuation; there was little evidence for more stable trait-like influences. These findings suggest that future research should focus on short-term fluctuations in stress, cortisol and health, as opposed to lengthy disease processes.

Effects of mood and rumination on cortisol levels in daily life: an ambulatory assessment study in remitted depressed patients and healthy controls

The influence of naturally occurring emotional and cognitive experiences on hypothalamic-pituitary-adrenal axis (HPAA) activity is still underinvestigated, particularly in clinical populations. The present study examined effects of mood and rumination on cortisol levels in daily life in remitted depressed patients with recurrent episodes or a chronic precourse (n=31) and healthy controls (n=32). Ambulatory assessment of subjective variables (valence, calmness, energetic-arousal, ruminative self-focus), daily stressors, and saliva cortisol samples was performed five times a day on two consecutive workdays, whereby cortisol was collected 20min after the subjective assessments. In addition, depressive symptoms and trait rumination (brooding, reflection) were measured retrospectively. Multilevel models revealed that remitted depressed patients showed lower cortisol activity compared to healthy controls. Depressive symptoms and trait rumination did not predict HPAA activity, whereas, by controlling for daily stressors, higher daily means of ruminative self-focus and lower daily means of valence, energetic arousal and calmness were associated with higher daily cortisol levels. Separate analyses per group revealed that mean daily ruminative self-focus predicted higher cortisol in both samples. In contrast, lower daily means of calmness, but also of valence and energetic arousal, were significantly linked to higher cortisol output only in healthy controls, but not in the patient sample. These findings indicate that naturally occurring rumination and low mood are associated with increased activation of the HPAA in daily life. Moreover, our data revealed a potentially reduced mood-cortisol coupling in remitted recurrent depression, possibly indicating that during the course of recurrent depression HPAA activation might become less responsive toward subtle emotional experiences in natural contexts.

Spouses' cortisol associations and moderators: testing physiological synchrony and connectedness in everyday life

In this study, associations were examined between cortisol levels of wives and husbands in 47 heterosexual married couples. Both partners' salivary cortisol levels were measured at the same moments seven times a day on 2 typical weekdays. After accounting for the effects of the diurnal rhythm of cortisol and relevant control variables, dyadic hierarchical linear modeling indicated significant positive linkages between partners' cortisol levels, consistent with the hypothesized within-couple physiological synchrony. Variables reflecting more (spousal presence) or less connectedness (loneliness, being alone) were also collected at the time of each cortisol sample. Results indicated that husbands' cortisol levels were higher at moments they reported feeling lonelier and lower at moments they were in the presence of their spouse. Wives' cortisol levels were higher at moments they were alone. In addition, wife-husband cortisol synchrony was stronger for husbands who spent relatively more time with their spouse across the study period-even after accounting for time spent with others in general. These findings suggest that marital partners evidence positive within-couple cortisol associations, and that connectedness (particularly physical closeness) may underpin spouses' physiological synchrony.

Salivary cortisol in ambulatory assessment--some dos, some don'ts, and some open questions

The impact of stress on health and disease is an important research topic in psychosomatic medicine. Because research on hypothalamic-pituitary-adrenal (HPA) axis regulation under controlled laboratory studies lacks ecological validity, it needs to be complemented by a research program that includes momentary ambulatory assessment. The measurement of salivary cortisol offers the possibility to trace the free steroid hormone concentrations in ambulant settings. Therefore, in this article, we first discuss the role of salivary cortisol in ambulatory monitoring. We start with a brief description of HPA axis regulation, and we then consider cortisol assessments in other organic materials, followed by a presentation of common salivary markers of HPA axis regulation suitable for ambulatory assessment. We further provide an overview on assessment designs and sources of variability within and between subjects (intervening variables), acknowledge the issue of (non)compliance, and address statistical aspects. We further give an overview of associations with psychosocial and health-related variables relevant for ambulatory assessment. Finally, we deal with preanalytical aspects of laboratory salivary cortisol analysis. The relative simplicity of salivary cortisol assessment protocols may lead to an overoptimistic view of the robustness of this method. We thus discuss several important issues related to the collection and storage of saliva samples and present empirical data on the stability of salivary cortisol measurements over time.

Differences in stress-related ratings between research center and home environments in dementia caregivers using ecological momentary assessment

BACKGROUND

Clinicians and researchers working with dementia caregivers typically assess caregiver stress in a clinic or research center, but caregivers' stress is rooted at home where they provide care. This study aimed to compare ratings of stress-related measures obtained in research settings and in the home using ecological momentary assessment (EMA).

METHODS

EMA of 18 caregivers (mean age 66.4 years ±7.8; 89% females) and 23 non-caregivers (mean age 66.4 years ±7.9; 87% females) was implemented using a personal digital assistant. Subjects rated their perceived stress, fatigue, coping with current situation, mindfulness, and situational demand once in the research center and again at 3-4 semi-random points during a day at home. The data from several assessments conducted at home were averaged for statistical analyses and compared with the data collected in the research center.

RESULTS

The testing environment had a differential effect on caregivers and non-caregivers for the ratings of perceived stress (p < 0.01) and situational demand (p = 0.01). When tested in the research center, ratings for all measures were similar between groups, but when tested at home, caregivers rated their perceived stress as higher than non-caregivers (p = 0.02). Overall, caregivers reported higher perceived stress at home than in the research center (p = 0.02), and non-caregivers reported greater situational demand in the research center than at home (p < 0.01).

CONCLUSIONS

The assessment method and environment affect stress-related outcomes. Evaluating participants in their natural environment provides a more sensitive measure of stress-related outcomes. EMA provides a convenient way to gather data when evaluating dementia caregivers.